Open Access
Research
What impact has the NIHR Academic Clinical Fellowship (ACF) scheme had on clinical academic careers in England over the last 10 years? A retrospective study Sally Clough,1 James Fenton,1 Helen Harris-Joseph,1 Leesa Rayton,1 Caroline Magee,1 David Jones,2 Lisa Ann Cotterill,1 James Neilson3
To cite: Clough S, Fenton J, Harris-Joseph H, et al. What impact has the NIHR Academic Clinical Fellowship (ACF) scheme had on clinical academic careers in England over the last 10 years? A retrospective study. BMJ Open 2017;7:e015722. doi:10.1136/ bmjopen-2016-015722 ►► Prepublication history and additional material are available. To view these files please visit the journal online (http://dx.doi.org/ 10.1136/ bmjopen-2016-015722).
Received 23 December 2016 Revised 21 March 2017 Accepted 7 April 2017
1
NIHR Trainees Coordinating Centre, Leeds Innovation Centre, Leeds, UK 2 NIHR Newcastle Biomedical Research Centre and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK 3 Department of Women’s and Children’s Health, The University of Liverpool, Liverpool, UK Correspondence to Dr Sally Clough; sally.clough@nihr.ac.uk
Abstract
Objectives The Academic Clinical Fellowship (ACF) was introduced to support the early career clinical and research training of potential future clinical academics in England. The driver for the model was concern about falling numbers of clinical academic trainees. This study examines the impact of the ACF model, over its first 10 years, in developing clinical academic careers by tracking the progression of ACF trainees. Design Retrospective analysis of National Institute for Health Research (NIHR) ACF career progression. This was performed using mixed methods including routine data collections of career destination, analysis of application rates to doctoral level fellowships and supplemented by survey information that captured the perceived benefits and challenges from previous ACFs and their current career activities. Participants 1239 NIHR ACFs who completed or left their posts between 2006 and March 2015. Results ACFs are perceived by the candidate population as attractive posts, with high numbers of applications leading to high fill rates. Balancing clinical and academic commitments is one of the reported challenges when completing an ACF. We have found that undertaking an ACF was shown to increase the likelihood of securing an externally funded doctoral training award and the vast majority of ACFs move into academic roles, with many completing PhDs. Previous ACFs continue to show positive career progression, predominantly in translational and clinical research. The knowledge acquired during the ACF continues to be useful in subsequent roles and trainees would recommend the scheme to others. Conclusions The NIHR ACF scheme is successful as part of an integrated training pathway in developing careers in academic medicine and dentistry.
Introduction The Integrated Academic Training (IAT) Programme was launched in October 2005 and became a flagship scheme of the National Institute for Health Research (NIHR) when it was established in 2006. This built on
Strengths and limitations of this study ►► This is the first cohort analysis of National Institute
for Health Research (NIHR) Academic Clinical Fellowship (ACF) career progression, providing evaluation of a novel career development model. ►► With over 1400 completed ACF posts and 10 years since the NIHR Integrated Academic Training pathway was introduced, it is timely to conduct this analysis. ►► The first career destination of previous ACFs were collected from their host partnerships, with known destinations reported for 83% of the cohort (17% unknown or unreported). ►► We have not measured the career progression of clinicians who have not completed an ACF but have entered clinical academia via an alternative route. ►► Analysis of a follow-up survey is presented as illustrative information as response rates (40%) were limited by a lack of up-to-date contact information.
recommendations published in a report1 of the Academic Careers Sub-Committee of Modernising Medical Careers and The UK Clinical Research Collaboration in March 2005, which identified the lack of a clear career structure as a barrier to junior doctors and dentists being able to establish themselves in academia alongside developing their clinical careers. The resultant IAT pathway combines academic and clinical training and incorporates the clinician scientist positions recommended and implemented from the earlier Savill report.2 The NIHR Academic Clinical Fellowship (ACF) was created as a new career development scheme and is the first step on the NIHR IAT pathway and provides predoctoral academic training during the specialty training period for doctors and dentists. The
Clough S, et al. BMJ Open 2017;7:e015722. doi:10.1136/bmjopen-2016-015722
1
Open Access ACF may be completed over a maximum of 3 years’ full time or 4 years for general practitioners and general dental practitioners, providing 25% of protected time over the course of the post for developing research skills alongside clinical training. The NIHR IAT Programme supports approximately 250 medical and 20 dental NIHR ACFs each year in England. Post are allocated on an annual basis to local IAT partnerships of Health Education England (HEE), higher education institutes, medical schools and NHS Trusts/organisations. Funding supports local hosting and management of the posts, covering basic salary, access to a local, formal academic research training programme, which provides general research skills, and a yearly £1000 bursary for the trainee to attend scientific meetings and conferences. The successful endpoint of an NIHR ACF is considered to be a funded application to undertake a research training award either immediately or later, depending on individual circumstances such as continuing in clinical training before pursuing a research training award. Trainees who decide to leave the academic pathway join an alumni programme that aims to support research studies elsewhere in the NIHR. To date, 2247 ACF posts have been funded by the NIHR since the scheme was launched, and over 40 additional, locally funded, ACF posts have also contributed to the programme. The scheme has evolved over time, with flexible entry level points that range from specialty or core training year 1 (ST1 or CT1) following foundation level training to ST3, for all General Medical Council or General Dental Council specialties. Entry at ST4 is also permitted for the six psychiatric specialities, paediatrics and emergency medicine posts. The entry level and the specialty is determined locally by the IAT partnerships who undertake recruitment following NIHR guidance and national recruitment processes. It is 10 years since NIHR ACFs were first advertised, and this study is the first published in-depth evaluation of career progression of the NIHR ACF post holders. The aim of the study was to determine whether the ACF programme has improved the access to clinical academic careers by providing clinicians with early career research training, enabling progression along a clinical academic pathway. Methods Information about NIHR ACF career progression has been collated from a number of sources. The first known academic career destinations of ACFs have been collected from host partnerships since 2006. NIHR application data were analysed to inform the progression of ACFs to PhD training positions, and success rates were compared using a two-tailed Z test to compare proportions. Gender information held by NIHR and collected from HEE on specialty post holders was analysed using a χ2 goodness-of-fit test and a two-tailed Z test to compare 2
proportions. For statistical tests, the significance threshold was set at .05. Additionally, a retrospective online survey was sent directly to individuals who had completed their awards in order to capture further details. The online survey was targeted at trainees who had been awarded NIHR ACFs since April 2006 and who had subsequently completed or left their award up to mid-March 2015, indicated by data collected from HEE Local Education and Training Boards (formerly postgraduate deaneries). Internet searches supplemented contact details already held by NIHR to provide email addresses for previous ACFs. However, due to the mobile nature of trainees, we know contact emails are changed on a regular basis, and we cannot confirm the survey reached all the intended recipients. Open-text answers were evaluated using thematic analysis. Results Since the scheme was launched, 2247 ACF posts have been funded by the NIHR. Of these trainees, 1239 had completed their ACF or left their post by the audit date and were included in the analysis. Application and fill rates Information on application rates for non-ACF doctors and dentists is currently being collected, but early indications suggest that NIHR ACF posts are highly competitive and attract a large number of applicants and will be the focus of a future study. For general practice, on average, over five applications per post have been received for ACFs in each round between 2011 and 2015. This compares to less than two applications that were made per GP ST1 post available in the same time period (data provided by GP National Recruitment (HEE). Subsequent fill rates of ACF posts are high and compare favourably with annual standard specialty recruitment figures (generally above 89% and now at a steady fill rate of 96% since 2013, supplementary figure 1). The proportion of females in a current ACF post was 48%, and the proportion of males was 52%. This difference was not statistically significant (approximately 750 posts). The equal gender distribution was also apparent for those who had completed ACF posts at the time of the audit (46% female and 54% male (over 1400 posts)). This balanced profile is however significantly different (p=0.0007) to the proportion of females in specialty trainee posts (data courtesy of HEE, November 2015) where a significantly greater number of trainees were female (57% of 11 160 current medical trainees *excluding ACFs, out of programme, locum appointments for training and foundation trainees, p
Research
What impact has the NIHR Academic Clinical Fellowship (ACF) scheme had on clinical academic careers in England over the last 10 years? A retrospective study Sally Clough,1 James Fenton,1 Helen Harris-Joseph,1 Leesa Rayton,1 Caroline Magee,1 David Jones,2 Lisa Ann Cotterill,1 James Neilson3
To cite: Clough S, Fenton J, Harris-Joseph H, et al. What impact has the NIHR Academic Clinical Fellowship (ACF) scheme had on clinical academic careers in England over the last 10 years? A retrospective study. BMJ Open 2017;7:e015722. doi:10.1136/ bmjopen-2016-015722 ►► Prepublication history and additional material are available. To view these files please visit the journal online (http://dx.doi.org/ 10.1136/ bmjopen-2016-015722).
Received 23 December 2016 Revised 21 March 2017 Accepted 7 April 2017
1
NIHR Trainees Coordinating Centre, Leeds Innovation Centre, Leeds, UK 2 NIHR Newcastle Biomedical Research Centre and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK 3 Department of Women’s and Children’s Health, The University of Liverpool, Liverpool, UK Correspondence to Dr Sally Clough; sally.clough@nihr.ac.uk
Abstract
Objectives The Academic Clinical Fellowship (ACF) was introduced to support the early career clinical and research training of potential future clinical academics in England. The driver for the model was concern about falling numbers of clinical academic trainees. This study examines the impact of the ACF model, over its first 10 years, in developing clinical academic careers by tracking the progression of ACF trainees. Design Retrospective analysis of National Institute for Health Research (NIHR) ACF career progression. This was performed using mixed methods including routine data collections of career destination, analysis of application rates to doctoral level fellowships and supplemented by survey information that captured the perceived benefits and challenges from previous ACFs and their current career activities. Participants 1239 NIHR ACFs who completed or left their posts between 2006 and March 2015. Results ACFs are perceived by the candidate population as attractive posts, with high numbers of applications leading to high fill rates. Balancing clinical and academic commitments is one of the reported challenges when completing an ACF. We have found that undertaking an ACF was shown to increase the likelihood of securing an externally funded doctoral training award and the vast majority of ACFs move into academic roles, with many completing PhDs. Previous ACFs continue to show positive career progression, predominantly in translational and clinical research. The knowledge acquired during the ACF continues to be useful in subsequent roles and trainees would recommend the scheme to others. Conclusions The NIHR ACF scheme is successful as part of an integrated training pathway in developing careers in academic medicine and dentistry.
Introduction The Integrated Academic Training (IAT) Programme was launched in October 2005 and became a flagship scheme of the National Institute for Health Research (NIHR) when it was established in 2006. This built on
Strengths and limitations of this study ►► This is the first cohort analysis of National Institute
for Health Research (NIHR) Academic Clinical Fellowship (ACF) career progression, providing evaluation of a novel career development model. ►► With over 1400 completed ACF posts and 10 years since the NIHR Integrated Academic Training pathway was introduced, it is timely to conduct this analysis. ►► The first career destination of previous ACFs were collected from their host partnerships, with known destinations reported for 83% of the cohort (17% unknown or unreported). ►► We have not measured the career progression of clinicians who have not completed an ACF but have entered clinical academia via an alternative route. ►► Analysis of a follow-up survey is presented as illustrative information as response rates (40%) were limited by a lack of up-to-date contact information.
recommendations published in a report1 of the Academic Careers Sub-Committee of Modernising Medical Careers and The UK Clinical Research Collaboration in March 2005, which identified the lack of a clear career structure as a barrier to junior doctors and dentists being able to establish themselves in academia alongside developing their clinical careers. The resultant IAT pathway combines academic and clinical training and incorporates the clinician scientist positions recommended and implemented from the earlier Savill report.2 The NIHR Academic Clinical Fellowship (ACF) was created as a new career development scheme and is the first step on the NIHR IAT pathway and provides predoctoral academic training during the specialty training period for doctors and dentists. The
Clough S, et al. BMJ Open 2017;7:e015722. doi:10.1136/bmjopen-2016-015722
1
Open Access ACF may be completed over a maximum of 3 years’ full time or 4 years for general practitioners and general dental practitioners, providing 25% of protected time over the course of the post for developing research skills alongside clinical training. The NIHR IAT Programme supports approximately 250 medical and 20 dental NIHR ACFs each year in England. Post are allocated on an annual basis to local IAT partnerships of Health Education England (HEE), higher education institutes, medical schools and NHS Trusts/organisations. Funding supports local hosting and management of the posts, covering basic salary, access to a local, formal academic research training programme, which provides general research skills, and a yearly £1000 bursary for the trainee to attend scientific meetings and conferences. The successful endpoint of an NIHR ACF is considered to be a funded application to undertake a research training award either immediately or later, depending on individual circumstances such as continuing in clinical training before pursuing a research training award. Trainees who decide to leave the academic pathway join an alumni programme that aims to support research studies elsewhere in the NIHR. To date, 2247 ACF posts have been funded by the NIHR since the scheme was launched, and over 40 additional, locally funded, ACF posts have also contributed to the programme. The scheme has evolved over time, with flexible entry level points that range from specialty or core training year 1 (ST1 or CT1) following foundation level training to ST3, for all General Medical Council or General Dental Council specialties. Entry at ST4 is also permitted for the six psychiatric specialities, paediatrics and emergency medicine posts. The entry level and the specialty is determined locally by the IAT partnerships who undertake recruitment following NIHR guidance and national recruitment processes. It is 10 years since NIHR ACFs were first advertised, and this study is the first published in-depth evaluation of career progression of the NIHR ACF post holders. The aim of the study was to determine whether the ACF programme has improved the access to clinical academic careers by providing clinicians with early career research training, enabling progression along a clinical academic pathway. Methods Information about NIHR ACF career progression has been collated from a number of sources. The first known academic career destinations of ACFs have been collected from host partnerships since 2006. NIHR application data were analysed to inform the progression of ACFs to PhD training positions, and success rates were compared using a two-tailed Z test to compare proportions. Gender information held by NIHR and collected from HEE on specialty post holders was analysed using a χ2 goodness-of-fit test and a two-tailed Z test to compare 2
proportions. For statistical tests, the significance threshold was set at .05. Additionally, a retrospective online survey was sent directly to individuals who had completed their awards in order to capture further details. The online survey was targeted at trainees who had been awarded NIHR ACFs since April 2006 and who had subsequently completed or left their award up to mid-March 2015, indicated by data collected from HEE Local Education and Training Boards (formerly postgraduate deaneries). Internet searches supplemented contact details already held by NIHR to provide email addresses for previous ACFs. However, due to the mobile nature of trainees, we know contact emails are changed on a regular basis, and we cannot confirm the survey reached all the intended recipients. Open-text answers were evaluated using thematic analysis. Results Since the scheme was launched, 2247 ACF posts have been funded by the NIHR. Of these trainees, 1239 had completed their ACF or left their post by the audit date and were included in the analysis. Application and fill rates Information on application rates for non-ACF doctors and dentists is currently being collected, but early indications suggest that NIHR ACF posts are highly competitive and attract a large number of applicants and will be the focus of a future study. For general practice, on average, over five applications per post have been received for ACFs in each round between 2011 and 2015. This compares to less than two applications that were made per GP ST1 post available in the same time period (data provided by GP National Recruitment (HEE). Subsequent fill rates of ACF posts are high and compare favourably with annual standard specialty recruitment figures (generally above 89% and now at a steady fill rate of 96% since 2013, supplementary figure 1). The proportion of females in a current ACF post was 48%, and the proportion of males was 52%. This difference was not statistically significant (approximately 750 posts). The equal gender distribution was also apparent for those who had completed ACF posts at the time of the audit (46% female and 54% male (over 1400 posts)). This balanced profile is however significantly different (p=0.0007) to the proportion of females in specialty trainee posts (data courtesy of HEE, November 2015) where a significantly greater number of trainees were female (57% of 11 160 current medical trainees *excluding ACFs, out of programme, locum appointments for training and foundation trainees, p
